Abstract TP056: Effectiveness and Safety of Tenecteplase in Patients with Large Vessel Occlusion Not Undergoing Thrombectomy: A Retrospective Cohort Study

Background: Tenecteplase (TNK) is increasingly used to treat patients presenting with acute ischemic stroke caused by large vessel occlusion (LVO) however, little is known about its effectiveness in people not undergoing endovascular thrombectomy. We evaluated neurological outcomes and safety in this subgroup of patients. Methods: We retrospectively reviewed patients treated with TNK from January 2022 to January 2024 at our institution. Of 391 patients treated with TNK, 74 had LVO stroke not treated with thrombectomy. Early neurological improvement was defined as a ≥4-point decrease on the NIHSS at 24–48 hours. Early neurological worsening was defined as ≥4-point increase on the NIHSS at 24-48h. Patients with less than 4-point change on the NIHSS were considered neurologically stable. Symptomatic ICH (sICH) was defined by SITS-MOST criteria. Demographics, comorbidities, discharge mRS, symptomatic intracranial hemorrhage (sICH), and recanalization rates were summarized. Comparisons used ANOVA or Kruskal-Wallis for continuous variables and Fisher’s exact test for categorical variables. Results: Our cohort had a mean age of 73.4±14.7 years, 55.4% were female, and the median initial NIHSS was 7 [IQR 4–17]. Early neurological improvement was seen in 41.2% of patients, 54.4% remained neurologically stable and 4.4% had early neurological worsening. At discharge (n=64), neurological improvement was documented in 50.0%, while 45.3% remained stable, and 4.7% worsened. Groups did not differ by demographics or comorbidities. Median discharge mRS was 1 for neurologically improved, 3 for stable, and 5 for worsened patients. Symptomatic ICH occurred in one patient, 1.4% of all patients, who had early neurological worsening. No sICH was seen in patients who remained stable or had early neurological improvement. (p=0.044). Conclusions: TNK was associated with meaningful early neurological improvement in nearly half and very low sICH rates in more than 95% of patients treated with TNK for LVO stroke. Early NIHSS improvement strongly correlated with favorable functional outcomes at discharge, supporting TNK’s effectiveness and safety in this understudied population.